NR 511 Week 1 exam NR 511 Differential Diagnosis and Primary Care- Final Exam Questions and answers with 100% accuracy

What is the goal of nursing research?

A. Make decisions regarding nursing education based on published literature

B. Determine topics that could develop nursing knowledge

C. Gather information from published literature to make decisions about application to clinical practice

D. Conduct studies to develop a body of nursing knowledge

D.

Conduct studies to develop a body of nursing knowledge

Which is the most important question to ask in evidence-based practice?

A. What findings constitute evidence?

B. How will the findings be used?

C. Is this a randomized controlled trial?

D. What theory is being utilized?

B.

How will the findings be used?

Nursing research should be utilized by:

A. Nurses at the bedside

B. Advanced practice nurses

C. Nurse researchers

D. Nurses at all levels of practice

D.

Nurses at all levels of practice

A clinical guideline may be found useful if the guideline was:

A. Published 2 years ago

B. Created using one group

C. Authored by a relatively unknown source

D. Funded by an anonymous source

A.

Published 2 years ago

Practice guidelines are designed to:

A. Be inflexible

B. Be utilized in every circumstance

C. Provide a reference point for decision making

D. Be created by a professional organization to guide the practice of a profession

c. Provide a reference point for decision making.

Which of the following is an example of determining whether a crucial element of a guideline is applicable to your patients?

A. There are no intended specific patients in the guideline.

B. You are a primary-care provider and the guidelines were written for primary-care providers.

C. Your patients have a much lower prevalence of a condition than the patients in the guideline.

D. You are a pediatric oncologist and the guidelines were written for geriatric specialists.

You are a primary-care provider and the guidelines were written for primary-care providers.

Which of the following would be considered the research design for Level I evidence?

A. Single, well-designed, randomized clinical trial

B. Systematic review of randomized clinical trial studies

C. Well-designed controlled trials without randomization

D. Systematic reviews of descriptive or qualitative studies

B.

Systematic review of randomized clinical trial studies

Which of the following would be considered the research design for Level II evidence?

A. Single descriptive or qualitative study

B. Well-designed case control or cohort studies

C. Single, well-designed, randomized clinical trial

D. Systematic review of randomized clinical trial studies

C.

Single, well-designed, randomized clinical trial

Which of the following would be considered the research design for Level III evidence?

A. Well-designed controlled trials without randomization

B. Systematic reviews of descriptive or qualitative studies

C. Systematic review of randomized clinical trial studies

D. Opinion of authorities and expert committees

A.

Well-designed controlled trials without randomization

Which of the following would be considered the research design for Level IV evidence?

A. Single descriptive or qualitative study

B. Opinion of authorities and expert committees

C. Systematic review of randomized clinical trial studies

D. Well-designed controlled trials without randomization

A.Well designed control trials without randomization

Which of the following would be considered the research design for Level V evidence?

A. Systematic review of randomized clinical trial studies

B. Well-designed controlled trials without randomization

C. Systematic reviews of descriptive or qualitative studies

D. Single descriptive or qualitative study

C.

Systematic reviews of descriptive or qualitative studies

Which of the following would be considered the research design for Level VI evidence?

A. Systematic reviews of descriptive or qualitative studies

B. Opinion of authorities and expert committees

C. Well--designed case control or cohort studies

D. Single descriptive or qualitative study

C.

Well--designed case control or cohort studies

Which of the following would be considered the research design for Level VII evidence?

A. Well-designed controlled trials without randomization

B. Opinion of authorities and expert committees

C. Well-designed case control or cohort studies

D. Single descriptive or qualitative study

B.

Opinion of authorities and expert committees

Identify the primary challenge for insurance carriers in today's health delivery model.

A. Preventing illness

B. Screening for disease

C. Educating the public

D. Reducing health-care spending

D.

Reducing health-care spending

Medicare benefits were offered to U.S. beneficiaries beginning in 1965. What was the service added with the Medicare D plan in 2006?

A. Health-care screening

B. Health-care education

C. Pharmaceutical coverage

D. Durable medical equipment coverage

C.

Pharmaceutical coverage

The cost of care provided by an APRN is approximately:

A. One-quarter that of a physician

B. One-third that of a physician

C. One-half that of a physician

D. One and one-half that of a physician

C.

One-half that of a physician

How do bundled payments differ from fee-for-service or global capitation?

A. Bundled payments are designed to reduce the number of payments to providers.

B. Bundled payments align payment to care outcomes delivered by the team.

C. Bundled payments reduce the amount of paperwork required for payment.

D. Bundled payments allow for streamlined and coordinated billing for providers.

B.

Bundled payments align payment to care outcomes delivered by the team.

Patients require education prior to accessing health-care services for the following reason:

A. Many patients do not understand policy benefits and payment responsibility.

B. Services may change across the beneficiary year.

C. Copayments and deductibles may have already been met by the patient.

D. Coding may need to be adjusted to meet the terms of the patient's benefits.

A.

Many patients do not understand policy benefits and payment responsibility.

What replaced the Sustainable Growth Rate (SGR) formula?

A. Advanced Alternate Payment Model (APM)

B. Merit-Based Incentive System (MIPS)

C. Medicare Access and CHIP Reauthorization

D. Quality Payment Program (QPP)

D.

Quality Payment Program (QPP)

Accounting keeps track of the financial state of a business. The accounting report that demonstrates the growth in assets is:

A. Net income statement

B. Balance sheet

C. Cash flow statement

D. Operating statement

A.

Net income statement

Medicare advantage plans are Medicare managed care organizations (MCOs). These plans must be approved by the Centers for Medicare and Medicaid Services (CMS) as alternative carriers for Medicare beneficiaries. Which of the following is not a characteristic of these plans?

A. Offer additional benefits

B. Offer lower copayments

C. Follow Medicare benefit rules

D. Follow the Commercial Carriers rules

C.

Follow Medicare benefit rules

The Current Procedural Terminology (CPT) and payment fee values are applicable only to CMS services and are regulated and paid by the regional CMS carriers. How does this impact MCOs?

A. MCOs are the only groups able to adjust standard payment rules.

B. MCOs can independently determine whether to utilize certain CPT code rules and/or the reimbursement values for the payment year.

C. MCOs can create personalized CPT codes.

D. MCOs must continue to use modifiers.

B.

MCOs can independently determine whether to utilize certain CPT code rules and/or the reimbursement values for the payment year.

All medical practices are required by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services. Why is this so critical?

A. Electronic software allows CMS to audit all medical practices' performance.

B. Electronic filing protects patient information as required by the Health Insurance Portability and Accountability Act.

C. Electric billing and automated electronic filing sets makes timely transition to new provider fee schedule rates possible.

D. Medical record software eliminates the possibility for duplicate bills and overcharging patients.

C.

Electric billing and automated electronic filing sets makes timely transition to new provider fee schedule rates possible.

All health-care practices should develop a compliance plan. Compliance plans offer practice safeguards that prevent which of the following?

A. Malpractice claims

B. Conflict-of-interest claims

C. Health Insurance Portability and Accountability Act violations

D. Safety and Health Administration violations

B.

Conflict-of-interest claims

What is the purpose of an Evaluation and Management Audit Tool?

A. To justify CPT coding

B. To provide guidelines for CMS review

C. To assist in estimating profit/loss for patient visits

D. To allow hospitals to comply with CMS guidelines

A.

To justify CPT coding

Each state has criteria defining the level of collaboration required between the Advanced Practice Registered Nurse (APRN) and an oversight physician. Which is among the questions an APRN should seek when selecting a practice setting?

A. List of practice limitations as an APRN

B. Standard hourly rate as office staff

C. Expectation for net revenue generation

D. Standard benefit package offered to office staff

C.

Expectation for net revenue generation

Identify one of the primary reasons for an APRN to develop a business plan:

A. To monitor monthly actual expense to budgeted expense

B. To reduce the likelihood of litigation action

C. To identify the marketing needed to grow the APRN practice

D. To assure accreditation standards are met

C.

To identify the marketing needed to grow the APRN practice

Despite the growth in the numbers of APRNs over the last decades, the role of the profession is often not understood by the public. What actions should APRNs undertake to market their services to the public?

A. Request that the physician act as an APRN spokesperson.

B. Increase articles in nursing professional journals about the APRN role.

C. Personally seek out the news media to communicate their value.

D. Rely on patients to communicate their benefits to neighbors.

C.

Personally seek out the news media to communicate their value.

Phases of diagnostic reasoning

-data acquisition

-hypothesis formation

-hypothesis evaluation

-problem naming

-goal setting

-therapeutic option consideration

-evaluation

Subjective data

CC, HPI, PMH, Social, ROS

Objective data

physical assessment findings

Assessment

DDX

Plan

diagnostics, meds, follow-up, and referral

Medical billing

process of submitting claims to receive payment

Medical coding

codes to communicate procedures performed and why

Common Procedure Terminology (CPT)

recognized universally. Service is represented by a 5 digit code in: Evaluation andMGMT, Anesthesiology, Surgery, Radiology, and Patho and Medicine

Medical coding ICD-10

shorthand for diagnosis

*every CPT must have a diagnosis

CPT coding E&M system

place of service (inpt vs outpt), type of service (consult, office visit, admitted), patient status (new vs established)

3 components of E & M coding

history, physical, medical decision making (risks, data, diagnosis)

Principles of epidemiology

the evaluation of distribution patterns and determinants of health and disease in population

Prevalence rate

refers to the number of cases of a particular disease at a particular time divided by the percentage of population at a point in time.

Incidence rate

the number of new cases of a disease diagnosed at a point in time

Specificity

ability of a test to correctly detect a specific condition

False negative

patient has condition but test results as negative

False positive

patient doesn't have disease but test results as positive

Sensitivity

has few false positives. The higher the sensitivity, less likelihood of false positives

Predictive value

likelihood that the pt has the condition partly depending on the prevalence of the condition in the population. If the condition is highly likely, a + test is more likely. If the condition if unlikely a + test is questioned for accuracy

OLDCART

Onset, Location, Duration,Characteristics, Aggravating factors, Relieving factors, and Treatment

Reimbursement for providers

fee for service. Reimbursement value for visit. Often determined by third party payers (Medicare, Medicaid,

Indemnity Insurance Companies, Managed Care Organizations, Workers Compensation, Veterans Administration, and Auto liability). All third-party payments are based on MPFS.

Differential Diagnosis

list of possible diagnosis usually listed in priority order

new patient vs established patient

whether or not seen in last 3 years

Primary prevention

examples: (supplements, immunizations, sunscreen, seat belts, nutrition counseling, exercise

Secondary prevention

detection of disease at it's early stages (screenings for skin cancer, breast cancer, HTN screening, mammograms)

Tertiary

-restoration of health and mgmt of disease-(dialysis in CKD, chemotherapy, statins for HLD)

SNAPPs

-Summarize (history and physical).

-Narrow-(narrow the differentials to 2 or 3).

-Analyze-(compare the DDX).

-Probe-Probe the preceptor (ask questions).

-P-Plan(come up with a specific plan).

-S-Self-directed learning (research topics that you are unaware of)

5 things to consider when ordering tests

cost

convenience

sensitivity

specificity

predictive value

prioritizing complaints

Requires a pt-centered approach, not enough time to address everything

Fee for Service

A model that is structured so a provider is given a set amount of monetary reimbursement for a specific visit/procedure performed that is adjusted for geographical location

Public payers

Government agencies (Medicare/Medicaid)

Private payers

insurance companies

Global Capitation

Global capitation is a payment model specifically for integrated health care delivery. In this model, capitation payment for services delivered by different providers or at different levels of care is combined into a single prospective payment to an integrated care organization or a large physician group.

insurance exchange

allows citizens to select a plan that meets their financial and health needs

Accountable Care Organizations

groups of providers—providers, hospitals, outpatient-care facilities—that come together to coordinate the care of patients, seeking to offer a high quality of care at a lower cost

Medicaid

offers medical assistance to individuals and families with low incomes and limited resources

Past medical history

childhood and other illnesses

surgical history

other hospital admissions

history of trauma

pregnancies

psychiatric diagnoses

randomized controlled trial

an experiment in which participants are randomly assigned to different conditions for the purpose of examining the effectiveness of an intervention

Specificity of a test

equal to the number of true negatives divided by the number of all tested individuals who do not have the disease.